Nutrition and Prostate Cancer. Marian L. Neuhouser, PhD, RD February 4, 2012

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1 Nutrition and Prostate Cancer Marian L. Neuhouser, PhD, RD February 4, 2012

2 Two Topics for Today Energy Balance/Weight and Prostate Cancer Dietary Supplements Harmful? Helpful? Indifferent?

3 Obesity and Prostate Cancer Risk in the Prostate Cancer Prevention Trial Gleason Grade Total Relative Risk P<0.02 P=0.31 P<0.01 BMI < N=1308 Gleason 2-6, 387 Gleason 7, 140 Gleason 8-10 Gong,Neuhouser et al CEBP. 2006

4 Obesity and Prostate Cancer Mortality United States 1.4 Relative Risk < Body Mass Index 4,004 deaths. ACS CPSII Cohort n=404,576 Calle, NEJM, 2003

5 Khamdekar et al Nature Rev Cancer Dec, 2011

6 Khamdekar et al Nature Rev Cancer Dec, 2011

7 Effects of low vs high glycemic load diets in on inflammatory factors and adipokines Nutrition Matters!! C-Reactive Protein (mg/l) * Leptin (ng/ml) * Adiponectin (ng/ml) * Fat Mass Fat Mass 0 Fat Mass Fat Mass 3850 Fat Mass *P=0.02 * P=0.13 * P=0.06 Fat Mass Neuhouser et al Journal of Nutrition 2012

8 Dietary supplement use in the United States Dietary supplements are used by over one-half of all Americans; usage is higher among cancer patients/survivors Consumers receive mixed messages from health care providers, scientists and lay advocacy groups about supplements Americans spend about $12 billion/year on dietary supplements Are supplements helpful or harmful for prostate cancer patients or for those at risk of prostate cancer?

9 Dietary Supplements & Prostate Cancer RISK Large study of nearly 300,000 men Excessive doses and using several types of supplements 2-fold increased risk of aggressive prostate cancer CARET (Neuhouser et al 2009) 50% increased risk of aggressive prostate cancer using CARET vitamins + 1 other SELECT Men randomized to vitamin E supplements 17% increased risk of prostate cancer

10 Dietary Supplements & Prostate Cancer Mortality Large cohort of men 15% increased risk of prostate cancer death for men who used multivitamins

11 Marketing of Dietary Supplements in the US Dietary Supplement and Health Education Act (DSHEA) of 1994: Public Law Definition of dietary supplements Burden of proof for safety lies with the FDA Statements of nutrition support Labeling Ingredients

12 Dietary bioactive compounds Resveratrol Grape and red wine Vinca vinifera Quercitrin Blueberry Vaccinium myrtillus, Ericaceae Coumestrol Soya beans Glycine max, Leguminosae Vitamin K 1 Daidzein Soya beans Glycine max, Leguminosae Folate Curcumin Turmeric Curcuma domestica, Zingiberaceae Sulforaphane Broccoli, Brasica oleracea Cruciferae Sinalbin White mustard Sinapis alba, Cruciferae Sinigrin Black mustard Brassica nigra, Cruciferae Glucobrassicin Horseradish Armoracia rusticana, Cruciferae Genistein Soya beans Glycine max, Leguminosae Indole-3-carbinol Cruciferous vegetables Cruciferae (-)Epigallocatechin-3-O-gallate EGCG Green tea Camellia sinensis, Theaceae

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14 Obesity and Prostate Cancer Risk in the PCPT Sample Prostate Cancer Prevention Trial (finasteride trial) 10,258 men (placebo only) 1,936 cancers 8,322 controls Endpoints 7-year period prevalence Grade 140 high (Gleason 8-10) 387 intermediate (Gleason 7) 1,300 low (Gleason 2-6) Characteristics Examined Age, race, family history, diabetes, finasteride treatment Body mass index Waist circumference

15 Abdominal Obesity and Prostate Cancer Risk in PCPT (Placebo Arm Only) 2.20 Relative Risk P=0.56 No Family History Waist Circumference <95 cm cm cm 108+ cm Family History P<0.02 No Family History: 869 cases, 3,495 controls Family History: 223 cases, 659 controls Gong, Neuhouser et al, 2006

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17 Obesity and Cancer Mortality in Men Prostate Non-Hodgkin s lymphoma All cancers All other cancers Kidney Multiple myeloma Gallbladder Colon and rectum Esophagus Stomach Pancreas Liver Calle, NEJM, Relative Risk

18 3 Questions Do supplements enhance or interfere with cancer treatments? Do supplements influence long-term survival? Do supplements affect quality of life in cancer patients?